Shiels William E, Coley Brian D, Kean John, Adler Brent H
Children's Radiological Institute, Department of Radiology, Columbus Children's Hospital, Columbus, OH 43205, USA.
Pediatr Radiol. 2007 Nov;37(11):1118-24. doi: 10.1007/s00247-007-0581-3. Epub 2007 Sep 4.
US readily demonstrates cartilaginous structures, and static sonography has shown potential in evaluating clubfoot deformity.
To investigate the potential of dynamic sonography in the evaluation of the congenital clubfoot.
Sonography was used for static and dynamic stress evaluation of 13 clubfeet and 35 normal feet in 24 patients (ages 0-32 weeks). Dynamic foot sonography was performed using a single-operator bimanual scanning technique. The examination involved coronal oblique evaluation of the medial malleolar-navicular (MMN) distance and the calcaneocuboid relationship, sagittal evaluation of the talonavicular relationship, and transverse evaluation of navicular subluxation, rotation, and deformation. Dynamic abduction/adduction stress maneuvers were performed, measured by the MMN.
The clubfoot "gristle" is a consistent, measurable soft-tissue landmark in clubfeet, connecting the medial malleolus to the medial navicular and talus. Mean MMN distances in clubfeet in the neutral position and abduction were significantly different from these distances in the normal paired foot (differences of 8.7 mm neutral position and 7.94 mm abduction), as compared to bilateral normal feet (differences of 0.98 mm neutral position and 1.43 mm abduction). Navicular subluxation showed good correlation between highly deformed and subluxated navicular bones and a tight medial clubfoot complex.
Focused dynamic foot sonography is useful in providing a specific and detailed functional preoperative and/or postoperative assessment of the congenital clubfoot.
超声易于显示软骨结构，静态超声已显示出在评估马蹄内翻足畸形方面的潜力。
探讨动态超声在评估先天性马蹄内翻足中的潜力。
对24例患者（年龄0 - 32周）的13只马蹄内翻足和35只正常足进行静态和动态应力超声检查。采用单操作者双手扫描技术进行足部动态超声检查。检查包括冠状斜位评估内踝 - 舟状骨（MMN）距离和跟骰关节关系、矢状位评估距舟关节关系以及横断位评估舟状骨半脱位、旋转和变形。进行动态外展/内收应力操作，通过MMN进行测量。
马蹄内翻足的“软骨”是马蹄内翻足中一个一致的、可测量的软组织标志，连接内踝与内侧舟状骨和距骨。马蹄内翻足在中立位和外展位时的平均MMN距离与正常对侧足的这些距离有显著差异（中立位差异8.7 mm，外展位差异7.94 mm），而双侧正常足之间的差异为（中立位差异0.98 mm，外展位差异1.43 mm）。舟状骨半脱位显示高度变形和半脱位的舟状骨与内侧马蹄内翻足复合体紧密之间具有良好的相关性。
聚焦的足部动态超声有助于对先天性马蹄内翻足进行术前和/或术后特定且详细的功能评估。
